Effectiveness of janus kinase inhibitors compared with biologic disease modifying anti‐rheumatic drugs on pain reduction in rheumatoid arthritis

ObjectiveTo compare the effectiveness of Janus kinase inhibitors (JAKis) and biologic disease‐modifying anti‐rheumatic drugs (bDMARDs) on pain in patients with rheumatoid arthritis (RA).MethodsIn this retrospective study, we investigated patients with a diagnosis of RA, starting treatment with a JAKi (n=1827), TNF inhibitor (TNFi, n=6422), IL‐6 inhibitor (n=887), abatacept (n=1102) or rituximab (n=1149) in 2017‐2019, using data from several linked Swedish national registers. Differences in change in pain, assessed with a visual analogue scale (VAS; 0‐100 mm), from baseline to 3 months, as well as proportions of patients remaining on initial treatment with low pain (VAS pain <20) at 12 months, were compared between treatments. Comparisons of treatment responses between JAKis and bDMARDs were evaluated using multivariable linear regression, adjusted for patient characteristics, comorbidities, current co‐medication and previous treatment.ResultsJAKi treatment was associated with a greater decrease in pain at 3 months compared with TNFi treatment (adjusted mean additional decrease: 4.0 mm; 95% confidence interval (CI) 1.6, 6.3), with similar trends in comparisons with non‐TNFi bDMARDs. More patients achieved low pain at 12 months on JAKis compared with TNFis, in particular among those previously treated with ≥2 bDMARDs (adjusted change contrast: 5.3 percentage points; 95% CI 1.0, 9.6).ConclusionJAKis had a slightly better effect on pain outcomes at 3 and 12 months compared with TNFis, with significantly greater differences in patients previously treated with ≥2 bDMARDs. The effect of JAKis on pain reduction was at least similar to that of non‐TNFi bDMARDs.